American Statistical Association
New York City
Metropolitan Area Chapter

Chapter Membership Application
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     Name: _______________________________________________________________________


     Organization: _______________________________________________________________


     Mailing Address: ____________________________________________________________


     City, State, & Zip Code: ____________________________________________________


     Telephone Number (With Area Code): __________________________________________


     Email Address: ______________________________________________________________


     Membership Type:  _____ Regular ($8.00)  _____ Student ($2.00)


     Comments: ___________________________________________________________________

     _____________________________________________________________________________

     _____________________________________________________________________________
Please make check or money order payable to:
American Statistical Association - New York City Metro Chapter

Mail the completed application and payment to:
Marcia Levenstein
Pfizer Inc.
235 East 42nd Street
Mail Stop: 685-13-06
New York, New York 10017-5755
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Page last modified on January 7, 2012

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